DEFINITIVE TREATMENT OF PRIMARY SPONTANEOUS PNEUMOTHORAX: A 10-YEAR EXPERIENCE

Authors

  • Eva Brysch Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • João Gonçalves Serviço de Cirurgia Cardiotorácica, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • Ricardo Ferreira Serviço de Cirurgia Cardiotorácica, Centro Hospitalar Universitário Lisboa Norte, Portugal; Faculdade de Medicina da Universidade de Lisboa, Portugal
  • André Sena Serviço de Cirurgia Cardiotorácica, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • Francisco Freitas Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Portugal
  • Paula Monteiro Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Portugal; Faculdade de Medicina da Universidade de Lisboa, Portugal
  • Ângelo Nobre Serviço de Cirurgia Cardiotorácica, Centro Hospitalar Universitário Lisboa Norte, Portugal; Faculdade de Medicina da Universidade de Lisboa, Portugal
  • Cristina Bárbara Departamento do Tórax, Centro Hospitalar Universitário Lisboa Norte, Portugal; Faculdade de Medicina da Universidade de Lisboa, Portugal

DOI:

https://doi.org/10.48729/pjctvs.57

Abstract

Objectives: Primary spontaneous pneumothorax (PSP) is defined as a pneumothorax without obvious underlying lung disease. Definitive treatment should be offered to patients with recurrent or persistent PSP. The aim of this study was to compare the effectiveness of medical pleurodesis (MP) with video assisted thoracic surgery (VATS) on definitive treatment of PSP.

Methods: 10 years’ retrospective study of PSP patients that underwent VATS or MP. Baseline characteristics, perioperative and follow-up data were compared.

Results: A total of 133 patients were included (MP=54; VATS=79). Baseline characteristics were similar between groups, with a male predominance (MP 83.6 vs VATS 85.5%) with a mean age of 24.78 and 25.81 years old, respectively. Post interventional length of hospital stay was similar (MP 4.94 vs VATS 4.47 days, p=0.20), but chest tube duration was longer in the VATS group (MP 2.94 vs VATS 3.56 days, p=0.03). The overall complications rate was low with no statistically significant difference between groups (MP 5/54 vs VATS 7/79, p=1.00). Regarding the follow-up, MP had a significant higher PSP recurrence rate (MP 11.1% vs VATS 1.3%, p=0.042), most occurring over the first two years.

Conclusion: Despite both MP and VATS are safe methods with short hospital stay and few complications associated, the results of this study show that VATS had a significantly lower rate of recurrences. Overall, VATS should be offered as the first line treatment to patients with PSP.

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References

MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax 2010; 65: Suppl. 2, ii18–ii31.

How CH, Hsu HH, Chen JS. Chemical pleurodesis for spontaneous pneumothorax. Journal of the Formosan Medical Association (2013) 112, 749e755

Tschopp JM, Bintcliffe O, Astoul P, Canalis E, Driesen P, Janssen J, et al. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 2015; 46: 321–335

Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001; 119:590–602.

Kelly AM, Clooney M. Deviation from published guidelines in the management of primary spontaneous pneumothorax in Australia. Intern Med J 2008; 38: 64–67.

Smit HJ, Chatrou M, Postmus PE. The impact of spontaneous pneumothorax, and its treatment, on the smoking behaviour of young adult smokers. Respir Med 1998; 92: 1132–1136.

Marquette CH, Marx A, Leroy S, et al. Simplified stepwise management of primary spontaneous pneumothorax: a pilot study. Eur Respir J 2006; 27: 470–476.

Gupta D, Hansell A, Nichols T, et al. Epidemiology of pneumothorax in England. Thorax 2000; 55: 666–671.

Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest 1987; 92: 1009–1012

Porpodis K, Zarogoulidis P, Spyratos D, Domvri K, Kioumis I, Angelis N, Konoglou M, et al. Pneumothorax and asthma. J Thorac Dis 2014;6(S1):S152-S161.

Beshay M, Kaiser H, Niedhart D, et al. Emphysema and secondary pneumothorax in young adults smoking cannabis. Eur J CardiothoracSurg 2007; 32: 834–838.

Johnson MK, Smith RP, Morrison D, et al. Large lung bullae in marijuana smokers. Thorax 2000; 55: 340–342.

Wu TC, Tashkin DP, Djahed B, et al. Pulmonary hazards of smoking marijuana as compared with tobacco. N Engl J Med 1988; 318: 347–351.

Gyorik S, Erni S, Studler U, Hodek-Wuerz R, Tamm M, Chhajed PN. Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax. Eur Respir J 2007; 29: 757–760

Tschopp JM, Boutin C, Astoul P, et al. Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study. Eur Respir J 2002; 20: 1003–1009.

el Khawand C, Marchandise FX, Mayne A, et al. Pneumothorax spontane. Resultats du talcage pleural sous thoracoscopie [Spontaneous pneumothorax. Results of pleural talc therapy using thoracoscopy]. Rev Mal Respir 1995; 12: 275–281.

Boutin C, Viallat JR, Aelony Y. Practical Thoracoscopy. Heidelberg, Springer, 1991.

Cardillo G, Carleo F, Giunti R, Carbone L, Mariotta S, Salvadori L, Petrella L, Martelli M.Videothoracoscopic talc poudrage in primary spontaneous pneumothorax: A single-institution experience in 861 cases. J Thorac Cardiovasc Surg 2006;131:322-328

Ayed AK. Suction versus water seal after thoracoscopy for primary spontaneous pneumothorax: prospective randomized study. Ann ThoracSurg 2003; 75: 1593–1596.

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Published

30-06-2020

How to Cite

1.
Brysch E, Gonçalves J, Ferreira R, Sena A, Freitas F, Monteiro P, Nobre Ângelo, Bárbara C. DEFINITIVE TREATMENT OF PRIMARY SPONTANEOUS PNEUMOTHORAX: A 10-YEAR EXPERIENCE. Rev Port Cir Cardiotorac Vasc [Internet]. 2020 Jun. 30 [cited 2022 Dec. 8];27(2):105-9. Available from: https://pjctvs.com/index.php/journal/article/view/57

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